Collaborative management of intracranial arteriovenous malformation

Objectives: To study all the cases of intracranial artereovenous malformation presented to a main neurosurgical center in Saudi Arabia and compare the results with reports from outside the Kingdom. To estimate the hospital-based prevalence of the disease which may reflect the frequency in the Saudi Arabia. Methods: A retrospective study was conducted to analyze the cases of intracranial arteriovenous malformation admitted to King Faisal Specialist Hospital and Research Center from 1982 to 1996. Results: A total of 97 patients were eligible for the present study. The characteristic aspects of intracranial arteriovenous malformation matched well with reports from other parts of the world. The hospital-based frequency was calculated to be 40 per 100,000 admissions. Most of the patients were men (2.5 men: woman). The average age at presentation was 29 years. More than half the patients presented with intracranial hemorrhage (52%); seizure was 2nd in frequency (32%). More than 80% of the arteriovenous malformations were in the supratentorial location, the rest were in the infratentorial location. According to the Spetzler and Martin grading system, 16 patients presented with grade I, 43 with grade II, 28 with grade III, 13 with grade IV, and one patient with grade V arteriovenous malformation. Three patients had double arteriovenous malformation. The patients were managed by single or combined procedures, which included surgery (28.9%), endovascular embolization (35.1%), and radiosurgery (16.5%). The complications included transient or persistent neurological deficit, status epilepticus, and immediate post-embolization intracerebral hemorrhage which proved fatal in one case. The different variables were tested for predictability of the risk of bleeding. The results were compared with those reported in the literature. Conclusion: Intracranial artereovenous malformation is not uncommon in Saudi Arabia. The patient presentation, arteriovenous malformation classification in each grade, and treatment outcome correlated well with other reports in the literature. The best obliteration rate was observed with surgical excision of the malformation (75%). No therapeutic modality was without complication.